A one-of-its-kind nursing home whose patients include extremely frail inmates paroled from the Connecticut Department of Correction has won certification from the federal Centers for Medicare & Medicaid Services—a move that will ease the strain on that state’s correctional health care coffers.
Correctional health experts say the December 2016 federal certification of the 60 West nursing facility in Rocky Hill, about 10 miles from Hartford, is a “huge deal” because it’s a potential treatment model for the growing number of American prisoners who are aging and infirm.
It is the first certification ever granted to a nursing home housing former inmates paroled largely because they’re physically and/or mentally debilitated.
“This gives people somewhere to go so they don’t have to die in a [prison] infirmary,” said Judith Dowd, health and human services director for Connecticut’s Office of Policy Management
The state contracted a private company, iCare Management, to run 60 West; federal rules forbid prison administrators from actually operating nursing homes.
Being certified means an estimated $5 million a year in federal Medicare and Medicaid funds—those dollars, in part, will match state allocations—could pour into the Connecticut’s correctional health care budget, predicted Dowd, who said the nursing home’s expenses amount to roughly $10 million annually.
A ‘Model’ for Other States
Calling it a “victory” with national implications, Dowd said, “Now, other states will have a model.”
Prison officials in several states, she added, have already asked how they can copy 60 West, but she would not disclose the names.
Several of the nation’s top correctional health experts told The Crime Report that prisons are not medically equipped to care for the most chronically, critically and paralyzingly ill patients—and that the higher costs of geriatric care will strain corrections budgets in the years to come.
The landmark certification is “particularly exciting,” said Steven Rosenberg, president of Community Oriented Correctional Health Services, an Oakland, California-based consultancy for prisons and jails nationwide.
“It speaks to the kind of federal-state partnerships we’re likely to see in the future. The federal government is starting to see that Medicaid [and Medicare are] underused tools that let states use their own discretion about who belongs behind bars and who is better off getting treatment in the community.”
Whatever patients’ physical or mental incapacities, other nursing homes often—and unfairly, experts said—have been reluctant to admit those with criminal convictions.
“Those inmates that are in for life are aging. One of the real problems that prisons, and even jails, are facing is what do we do when people are that debilitated and they don’t fit the correctional model?” said Donna Strugar-Fritsch, a correctional health care strategist and principal with Lansing, Michigan-based Health Management Associates.
Calling the certification a “huge deal,” Strugar-Fritsch added that aging, frail prisoners “cannot follow rules because they don’t understand rules, and cannot dress themselves. What do we do about people who can’t feed themselves? That’s not prison work.”
Initially, the Centers for Medicare & Medicaid Services had denied Connecticut’s certification application for 60 West.
The facility opened in 2013 amid protests from residents of the bedroom community where it’s situated who worried that the nursing home inmates were a safety threat. State officials who spent the last two years or so resolving issues related to the certification, called the concerns unfounded.
(60 West, for example, contains a secured unit for dementia patients who might wander off.)
Those treated at the 95-bed facility have included both old and young residents with terminal and chronic physical illness—as well as those with psychiatric disorders who had previously been housed and treated at other state and municipal facilities.
Tempering praise for the federal certification were warnings that Medicare and Medicaid officials have much to work out regarding their funding of correctional health.
For one, Strugar-Fritsch pointed out, federal rules do not allow Medicare or Medicaid funding for nursing homes that are locked and guarded in the same way as prisons. That’s why 60 West only takes parolees.
And there also remains unresolved the question of how to address wheelchair-bound and bed-ridden inmates who may never be paroled, Strugar-Fritsch added.
Connecticut’s Dowd said the state pressed its case for the federal certification because of the fiscal impact of caring for acutely ill individuals who are confined behind the walls of prisons that are wholly unequipped to provide such care.
But she also added that Connecticut officials believed they were following the U.S. Supreme’s Court 1999 Olmstead v L.C. ruling that treatment for individuals with disabilities should be administered in appropriate community settings instead of institutions.
(That Supreme Court decision centered on persons with mental illness, a group that increasingly and disproportionately ends up in jails and prisons.)
“It’s been a long process. People were patient because they knew it was the right thing to do,” Dowd said.
Editor’s Note: For an earlier story on current research spotlighting the problems of America’s aging prisons, see Katti Gray’s Nov 7, 2016 article in TCR.
Katti Gray, a contributing editor of The Crime Report, covers criminal justice, health and education. She welcomes your comments.